Ivabradine Indication — EECC MCQ

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EasyHeart FailureIvabradine IndicationEECC

A 70-year-old man with HFrEF (LVEF 30%) in sinus rhythm has a resting heart rate of 82 bpm despite bisoprolol 10 mg daily (maximally tolerated dose). He remains in NYHA class II. Which additional agent is recommended to further reduce heart rate?

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Correct answer: A — Ivabradine

Ivabradine selectively inhibits the If (funny) current in the sinoatrial node, reducing heart rate without affecting contractility or blood pressure. The SHIFT trial demonstrated that ivabradine reduces the composite of CV death and HF hospitalisation in HFrEF patients in sinus rhythm with HR ≥70 bpm despite maximally tolerated beta-blocker. The ESC HF Guidelines recommend ivabradine in this setting (Class IIa, LOE B). Non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are contraindicated in HFrEF due to negative inotropy. Digoxin does not reduce mortality and has a narrower therapeutic index. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: ESC (2023): Focused Update on Heart Failure: https://bnf.nice.org.uk/